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Evidence-Based Practice: A Process for Practical Implementation

Evidence-Based Practice: A Process for Practical Implementation. Leonard Gibbs, University of Wisconsin—Eau Claire & Stanley McCracken, University of Chicago. Agenda.

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Evidence-Based Practice: A Process for Practical Implementation

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  1. Evidence-Based Practice: A Process for Practical Implementation Leonard Gibbs, University of Wisconsin—Eau Claire & Stanley McCracken, University of Chicago

  2. Agenda • 9:00 – 10:00 Our Mission, Facts Regarding Emergence of EBP Now, Definitions of EBP by Concept, Operation, EBP Team Skills Example (DVD) • 10:00 – 10:30 Four Elements of Well-Built COPES Questions and Six Types • 10:30—10:40 Importance of Posing Well-Built Questions, First Group Exercise • 10:40-10:50 A Single Case Applying One COPES Question and Worksheets Demonstrating the EBP Process

  3. Agenda • 10:50-11:30 Group Exercises Posing Well-Built COPES Questions (We circulate to help groups.) • 11:30-11:50 Search Techniques to Demonstrate the Following: Search Planning, Appropriate MOLES, Boolean Logic, Appropriate Databases, Search History, Criteria for Rating Evidence • 11:50-12:00 Len’s Website • 12:00-1:00 (Sharp) Lunch Individuals in Groups Practice Posing Their Own Well-Built Questions (each person bringing one question back from lunch)

  4. Agenda After Lunch • 1:00-1:30 Some Morning’s Questions Searched, Critical Appraisal Skills Program and Len’s Evidence Rating Forms; Participants Read Their COPES Questions; Live Search • 1:30-1:50 Cheese Head Competition (For marker documents) • 1:50-2:50 Len & Stan & Helpers Circulate, Participants Conduct Their Own Searches (Keeping a search history for later reference) • 2:50-3:00 What Have We Learned?

  5. Our Mission • Help Children and Adolescents • Incorporate Elements of Evidence-Based Practice In the Process of Helping

  6. The Spirit of Evidence-Based-Practice • Essential, Elemental, Primary Element in Evidence-Based Practice: Searching for Disconfirming Evidence With Same Determination as for Confirming Evidence.

  7. Forces Making Evidence-Based Practice Possible Database Availability Study Syntheses EBP Internet Access and Speed New Search Methods Based on Well-Built Questions

  8. Internet Speed • Optical devices built on silicon chips could effortlessly transfer oversize digital files…at rates of 10 gigabits a second….” (Jalani, Feb. Issue of Scientific American, 2007, p, 59)

  9. Database Availability • ERIC • Cochrane Library Abstracts • PubMed • Bandolier “evidence based thinking about health care” • My book’s website: http://www.evidence.brookscole.com/

  10. Study Syntheses • Cochrane Library • Campbell Collaboration

  11. New Search Methods and New Skills • Critical Appraisal Skills Program (CASP) http://www.phru.nhs.uk/casp/critical_appraisal_tools.htm • Boolean Logic • Database Thesauruses • Methodological Filters

  12. Clinical state and circumstances Clinical Expertise Client Preferences and actions Research Evidence Newest EBP Model Haynes, Devereaux, and Guyatt, 2002

  13. EBP Is Not: • What we have been doing all along with a new name • Slavish adherence to research evidence alone to direct our practice • A term with a universally accepted and agreed on definition

  14. EBP Defined by Concept • Evidence-based medicine (EBM) requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances (Straus, Richardson, Glasziou & Haynes, 2005, p.1)

  15. EBP Defined by Concept • “Placing the client’s benefits first, evidence-based practitioners adopt a process of lifelong learning that involves continually posing specific questions of direct practical importance to clients, searching objectively and efficiently for the current best evidence relative to each question, and taking appropriate action guided by evidence.” (Gibbs, 2003, p. 6)

  16. EBP Defined by Operation • Become Motivated to Apply EBP (My Step Added) • Step 1—Convert information need (prevention, assessment, treatment, risk) into an answerable question. • Step 2—Track down the best evidence to answer the question. • Step 3—Critically appraise the evidence for its validity (closeness to the truth) impact (size of the effect) and applicability (usefulness in our practice).

  17. EBP Defined by Operation • Step 4—Integrate critical appraisal with our practice experience, client’s strengths, values circumstances. • Step 5—Evaluate effectiveness and efficiency in exercising steps 1-4 and seek ways to improve them next time. • Step 6—Teach others to follow the same process (based on Sackett et al., 2000)

  18. Definition by Example: Interdisciplinary EBP Team Skills • General Question Posed • Client Oriented Practical Evidence Search Question (COPES) • Search Planning • Handling Problems (with searching) • Appraising the Evidence • Drawing Conclusions Based on Evidence

  19. What Little We Know About Interdisciplinary EBP Team Skills • Aron Shlonsky & Michael Saini, University of Toronto, EBP within an Interdisciplinary / Multidisciplinary Team Context: An analysis of peer-reviewed publications • Searched In Published and Gray Literature Finding 2045 abstracts • Applying the Criteria on the Next Slide

  20. Shlonsky and Sinai’s Inclusion Criteria 1) Use of Multidisciplinary / Interdisciplinary / Cross disciplinary / Transdisciplinary / Interprofessional team: Yes / No 2) Study on an individual or group: Yes / No 3) There is some evidence that the author(s) used an Evidence Based Practice Process at the individual client/patient level: • Problem Identification: Converting information needs into an answerable question: Yes / No • Evidence Search: Finding, with maximum efficiency, the best evidence with which to answer the question: Yes / No • Critique: Determining the merit, feasibility and utility of evidence: Yes / No • Synthesis: Combining findings from all evidence to make a practice recommendation: Yes / No

  21. Finding Regarding Effectiveness of Interdisciplinary EBP Teams: One Article, So Far: Akobeng, A. K. (2005). Evidence in practice. Archives of Disease in Childhood, 90(8), 849-852.

  22. Importance of Posing Well-Built Questions

  23. EBP Defined by Example: Situation A 60 year old white male is in his doctor’s office reviewing laboratory test results with his doctor. The patient’s grandfather died of prostate cancer; his mother died of breast cancer; his father died of esophageal cancer, and his sister has breast cancer. His doctor says: “Your PSA is up a bit (.8 to 1.9 in 20 months), but we will have to watch it.”

  24. EBP Defined by Example: Posing a Well-Built Question Question: For a sixty year old with a family history of cancer, with a PSA of .8 moving to 1.9 in 20 months, what is the probability that he has prostate cancer?

  25. You can find out the probability at this website: • Enter into Google this phrase: evidence-based practice as if you life depended on it. • http://www.uwec.edu/lgibbs/index.htm

  26. One Real Example Regarding a Case Showing Use of Handouts • Child Sex Abuse Case • Search Plan Related to the Case • Search History Related to the Case

  27. Four Elements of Well-Built COPES Questions of Six Types

  28. Posing Well-Built, Answerable, Practice Questions

  29. COPES Questions • Client-Oriented • Practical • Evidence-Search Gibbs, L. E. (2003). Evidence-based practice for the helping professions: A practical guide with integrated multimedia. Pacific Grove, CA: Brooks/Cole.

  30. Research Question COPES Question

  31. Formulating Effectiveness/Prevention Questions: a)Comparing an intervention to no intervention b) Comparing two interventions c) What is the best intervention?

  32. Formulating Assessment/Risk Questions: a) Comparing an assessment instrument/ procedure to no assessment b) Comparing two assessment instruments/ procedures c) What is the best assessment instrument/ procedure?

  33. Formulating Descriptive (Quantitative) Questions: a) Summarizing characteristics (how much, how many, what percentage, what is the average?) b) Asking about relationships between variables

  34. Formulating Descriptive (Qualitative) Questions: a) Require narrative responses b) Suggest in-depth explorations, little known phenomena (how would they describe, what is the process, how do they experience?)

  35. Four Features of a Well-Built Question and Types of Questions

  36. This format from Gibbs (2003) follows Sackett, D. L., Richardson, W. S., Rosenberg, W. & Haynes, R. B.(1997). Evidence-based medicine: How to practice and teach EBM. New York: Churchill Livingstone.

  37. Practice Posing COPES Questions • You need: • Sheet marked “Five types of questions typically emerge in practice” • Sheet with “Example ADHD Q.” in upper left corner • Clinical Scenarios for Question Posing Exercises • Three teammates to practice posing questions

  38. Search Techniques

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